Benign/Malignant Lesions

Question 1

24F teacher presents to ENT clinic for evaluation of dysphonia. Patient states she uses her voice excessively at work. Her hoarse voice has been present for 6mos and is getting worse. Her voice is starting to affect her ability to teach. She denies other symptoms. On flexible stroboscopy, there are b/l lesions of the membranous VCs. There is an abnormal mucosal wave b/l. The airway is widely patent and the VCs move b/l. What is the most appropriate first step in mgmt. 1st step in mgmt?

Answer 1

Increase fluid hydration and voice therapy.

(VC nodules occur at ant. 2/3rds of the membranous VCs. Excessive vibration of the VCs creates forceful collision of the VCs resulting in localized edema/inflammation. If this VC abuse continues, hyalinization of Reinke’s space can occur resulting in VC nodules. VC nodules are a direct result of vocal abuse and over-use, thus voice rest and voice therapy is the 1st line treatment).

Question 2

_ (statistical parameter) is affected by disease prevalance.

Answer 2

Positive predictive value (PPV)

Question 3

_ is the 1st line treatment for ALL types of hemangiomas.

Answer 3

Propanolol

Question 4

VF ___ and ___ are absolute contraindications to professional voice use, due to risk for further injury.

Answer 4

VF hemorrhage and tears

Question 5

“small sessile gray mass”

Answer 5

Granular cell tumor

Question 6

Histopathology reveals pseudoepitheliomatous hyperplasia and stains +PAS and +S-100.

Dx?

Answer 6

Granular cell tumor

Question 7

Dysplasia is described on the basis of ___ of the cellular atypia in the epithelium.

Answer 7

Thickness of the cellular atypia

Question 8

Mild dysplasia can progress to invasive in approximately …

Answer 8

11% of patients

Question 9

The risk of malignant transformation with severe dysplacia and carcinoma insitu

Answer 9

30%

Occurs ~5 years after diagnosis of dysplsia

Question 10

Patients w/idiopathic VF paralysis will have at least some recovery w/in 6 months of diagnosis in ___ of patients.

Answer 10

20-40% of patients

Question 11

Patients w/idiopathic VF paralysis will have at least some recovery w/in ___ months of diagnosis in 20-40% of patients.

Answer 11

6 months

Question 12

Severe dysplasia of the TVFs carries a risk of malignant transformation of __%.

Answer 12

30%